Docencia de fisioterapia en las escuelas andaluzas / Teaching in physiotherapy's andalusian schools

En este trabajo se analizan los cambios producidos en la disciplina de electroterapia, hidroterapia y termoterapia, que es impartida en el primer curso de la diplomatura de Fisioterapia de Cádiz con motivo de la renovación de los planes de estudios. Asimismo se compara esta asignatura con las de igual contenido impartidas en el resto de escuelas andaluzas. También comprobamos la planificación docente específica de Fisioterapia de primer curso de las citadas escuelas con el fin de saber si existe docencia unificada, dado que ésta es la única forma de mejorar y completar la enseñanza, además de conseguir docencia de calidad (AU)

Fisioterapia y esclerosis lateral amiotrófica / Physioterapy and esclerosis lateral amiotrofica

La esclerosis lateral amiotrófica (ELA) es una enfermedad de la motoneurona superior e inferior, con afectación bulbar variable, sin alteraciones mentales, sensitivas, sensoriales ni esfinterianas. El objetivo de este trabajo es aportar nuestra experiencia profesional como fisioterapeutas, proponiendo un protocolo de exploración y tratamiento de estos pacientes, aunque destacando la importancia del tratamiento individualizado, que debe ser revisado y adaptado periódicamente según la situación clínica del sujeto (AU)

Control de calidad de la docencia de las estancias clínicas en los estudios de Fisioterapia / Quality control of the teaching of the clinical stays on the study of Physiotherapy

Una de las responsabilidades de los docentes es garantizar la calidad formativa de los estudiantes. Para determinar la magnitud de la calidad educativa y las causas de su variabilidad y su modificación en el sentido deseado es necesario que los docentes, como los fabricantes de cualquier proceso productivo, nos basemos en tres pilares fundamentales: -- Obtener información desde la producción.-- Compararla con requerimientos cualitativos establecidos para la producción.-- Incidir en el proceso de producción. Tras analizar los conceptos de calidad absoluta, máxima y óptima, y los diferentes elementos que intervienen en la calidad educativa de la docencia en Fisioterapia (profesorado, alumnado y recursos), los autores proponen diversos estándares que permitan el control de dichos elementos con el objetivo de optimizar la calidad de las estancias clínicas de Fisioterapia, parte fundamental en la formación de los futuros profesionales (AU)

Increasing uterine receptivity by decreasing estradiol levels during the preimplantation period in high responders with the use of a follicle-stimulating hormone step-down regimen.

OBJECTIVE: To analyze the effect on uterine receptivity of a decrease in E2 levels during the preimplantation period with the use of a step-down regimen in high responders undergoing IVF. DESIGN: Prospective controlled clinical study. SETTING: The Instituto Valenciano de Infertilidad. PATIENT(S): High responders in whom at least one previous IVF attempt failed in which 3-4 good-quality embryos were transferred and E2 levels were >3,000 pg/mL on the day of hCG administration. INTERVENTION(S): Gonadotropins were administered according to two different protocols. Blood samples were collected and IVF was performed. MAIN OUTCOME MEASURE(S): Serum E2 levels and reproductive outcome of IVF. RESULT(S): Estradiol levels on the day of hCG administration and throughout the preimplantation period and the number of oocytes collected were significantly lower with the use of the step-down regimen than during the previous failed cycle in which the standard protocol was used. The fertilization rate was similar and the number of good-quality embryos transferred was comparable. However, the implantation and pregnancy rates were significantly improved in patients who underwent the step-down regimen compared with those who received the standard protocol. CONCLUSION(S): With the use of a step-down regimen with FSH in high responders, our clinical results demonstrate that uterine receptivity can be improved when E2 levels are decreased during the preimplantation period.

Endogenous LH surge versus hCG as ovulation trigger after low-dose highly purified FSH in IUI: a comparison of 761 cycles.

PURPOSE: The results obtained with a protocol consisting of ovarian stimulation with low doses of highly purified FSH (FSH HP), administration of a GnRH analogue to induce an endogenous surge of gonadotropins, and IUI were evaluated. These results were compared with those seen with similar FSH stimulation and hCG administration followed by IUI. METHODS: Three hundred sixty-four patients scheduled for IUI, after inclusion in a total of 345 FSH HP/GnRH-stimulated cycles and 416 FSH HP/HCG-stimulated cycles, were studied. The stimulation protocol consisted of daily subcutaneous injection of 75 IU of FSH HP from day 3 or 5 of the cycle, depending on the duration of the spontaneous cycle. hCG was administered on days 0, +2, and +5 to support the luteal phase. Monitoring was conducted using circulating estradiol levels and vaginal ultrasonography. Administration of two s.c. doses of leuprolide acetate (LA) or 7500 IU of i.m. hCG when at least one 18-mm-diameter follicle was seen and estradiol levels reached 120 pg/ml per follicle with a diameter > or = 16 mm. Intrauterine insemination was with semen capacitated by swim-up, thawed at room temperature if previously frozen. RESULTS: The ovulation rate was 99.28 after hCG and 99.23 with LA. No significant differences were seen between the estradiol and progesterone levels of both groups or in the estradiol/progesterone ratio. The duration of the luteal phase was similar in both groups. Pregnancy rates per cycle were 17.31% (hCG) and 27.25% (LA), respectively (P = 0.0007), and abortion rates 22.22% (hCG) and 24.47% (LA), respectively. No cases of ovarian hyperstimulation were seen. CONCLUSIONS: After FSH HP administration according to a low-dose protocol, the use of LA to trigger a gonadotropin surge as a means of inducing ovulation in FSH-stimulated women could be a good alternative to improve the results and prevent ovarian hyperstimulation in IUI cycles.

The safety and effectiveness of stepwise and low-dose administration of follicle stimulating hormone in WHO group II anovulatory infertile women: evidence from a large multicenter study in Spain.

PURPOSE: Our goal was to investigate the safety, effectiveness, and feasibility for the practicing physician of stepwise and low-dose administration of FSH in WHO group II anovulatory infertile women. METHODS: Infertile female patients (n = 234) suffering from WHO group II anovulation, and who failed to became pregnant with clomiphene citrate, were included in a multicenter, prospective, clinical study of treatment with a protocol of chronic low-dose and small incremental rises with urinary purified or highly purified FSH. Follicular development was monitored with ultrasonographic scans. RESULTS: The 234 patients received a total of 534 cycles of treatment, for a mean number of 2.3 treated cycles per patient. hCG was withheld in 65 (12.2%) cyles because of no response and in 28 (5.2%) cycles because of hyperresponse. Of the remaining 441 cycles, 419 (95%) were ovulatory, and in 198 (47.3%) of these cycles a single dominant follicle developed. There were 93 pregnancies (39.7% per patient), for a cycle fecundity rate of 17.4%. Cumulative conception rate after two treated cycles was 33.5%. There were 14 (15%) pairs of twins and 10 (10.8%) spontaneous miscarriages. The prevalence of complications was low with no cases of severe OHSS. Basal LH/FSH ratio was significantly higher in the pregnant group of patients than in nonpregnant women. CONCLUSIONS: Stepwise and chronic low-dose administration of FSH is a safe and effective method for treatment of WHO group II anovulatory infertility, mainly in those patients having high LH/FSH ratios.

Effect of recombinant human luteinizing hormone versus human chorionic gonadotrophin: effects on ovulation, embryo quality and transport, steroid balance and implantation in rabbits.

A total of 40 New Zealand female rabbits which had been given follicular stimulation and artificial insemination received 50 IU of either recombinant human luteinizing hormone (rhLH; n = 20) or human chorionic gonadotrophin (HCG; n = 20) to induce ovulation. In each hormone group, 10 animals were killed 72 h later to study the ovulatory process and the number, location, morphological quality and variation in the degree of development of recovered embryos. Pre-ovulatory and post-ovulatory oestradiol and progesterone concentrations were determined in these 10 animals; the remaining 10 animals of each group were killed at 14 days to study implantation up to day 14. At 72 h the number of luteinized follicles and the total number of embryos in the rhLH group were lower than in the HCG group, and the number of pre-ovulatory follicles was higher. The percentage of good quality embryos was higher with rhLH, whereas the percentage of degenerated embryos was lower. Oviductal transit of the embryos was slower and variation in the degree of embryo development greater after HCG. Progesterone concentrations were comparable with pre-ovulatory concentrations at 24 h in the rhLH group, but not in the HCG group where they increased. In the study performed at 14 days, the implantation rate was significantly higher with rhLH versus HCG. These observations suggest that rhLH induces a lower number of follicles to ovulate than does HCG, probably due to its shorter half-life; however, the better embryo quality produced by rhLH may ultimately lead to a better implantation rate; rhLH may mimic the physiological endogenous LH surge more closely than HCG.

Recombinant-human luteinizing hormone (r-hLH) as ovulatory stimulus in superovulated does.

PURPOSE: To study the effects of r-hLH as ovulatory stimulus in does. METHOD: New Zealand does, 18 wk old, in estrus, received 25 IU of pregnant mare serum gonadotropin (PMSG) followed at 48 h either by 50 IU of r-hLH (n = 20) or hCG (n = 20) to induce follicular growth and ovulation. All does were previously artificially inseminated to avoid endogenous LH surge. Half of the animals receiving r-hLH (n = 10) or hCG (n = 10) were killed at 72 h after the hormone administration, and the remaining half were killed at 14 days. At 72 h the number of corpora lutea and preovulatory follicles was determined, and fertilization rate, embryo quality, degree of embryonic development, and oviductal transit were all assessed. On day 14 the number corpora lutea and implanted embryos were counted, and implantation rate was determined. Median and interquartile ranges were calculated for each parameter. RESULTS: At 72 h the median for corpora lutea was 8 (7-10) in the r-hLH group vs 13 (10-14) in the hCG group (P = 0.009); preopvulatory follicles were 7 (6-10) vs 0 (0-0) (P = 0.0007); the percentage of good-quality embryos was 71.4% (54.5-75) vs 33.3% (25-37.5) (P = 0.001), for intermediate-quality embryos it was 25% (14.3-36.4) vs 33.3% (25-38.5), and the percentage of degenerated embryos was 0% (0-12.5) vs 33.3% (25-37.5) (P = 0.015), respectively. Fertilization rates were similar in both groups. Embryonic development was more homogeneous in the animals receiving r-hLH (8 to > or = 16 cells) compared to those receiving hCG (2 to > or = 16 cells). The median of embryos still in oviducts at 72 h was significantly higher in the hCG group [6 (4-13)] than in the r-hLH group [0 (0-4)] (P = 0.41). At 14 days the median of corpora lutea was higher in the hCG [12 (11-16)] than in the r-hLH group [10 (7-13)] (P = 0.008), but no differences were noted in the number of implanted embryos. Implantation rate was higher in the r-hLH group [100 (92.3-100)] than in the hCG group [87.5 (83.3-94.1)] (P = 0.056). CONCLUSIONS: At the studied dose an ovulatory stimulus with r-hLH induced fewer follicles to ovulate than hCG. Recombinant-hLH produced superior embryo morphological quality, a more homogeneous degree of embryo development, and more synchronous embryo transit than hCG. In spite of the larger number of ovulations following hCG, subsequent events essential for pregnancy were higher with r-hLH, offsetting differences in terms of implanted embryos at 14 days of pregnancy.